Download Safety and Benefits of Alternative Sweeteners-2016

Safety and Benefits of
Alternative Sweeteners
Mitchell A. Cheeseman, Ph.D.
On behalf of
Calorie Control Council
[Thanks to Berna Magnuson for the
loan of slides]
The Calorie Control Council
Alternative Sweeteners Available for Use
•
•
•
•
•
•
•
•
•
Advantame
Acesulfame K
Aspartame
Cyclamate
Monk Fruit Extract
Neotame
Saccharin
Stevia
Sucralose
•
•
•
•
•
•
•
•
Erythritol
Isomalt
Lactitol
Maltitol
Mannitol
Polyglycitol
Sorbitol
Xylitol
Approved around the world
• All sweeteners approved for use by
JECFA have been thoroughly tested
and ADIs established.
• Maximum use levels in foods and
beverages ensure no consumer
exceeds ADI for each sweetener.
• Use of new sweeteners & mixtures
lowers risk of exceeding ADI.
So if these sweeteners are safe,
why is there controversy?
In most cases, controversy based on
• Adverse effects seen in high dose
animal experiments
– But are not relevant at ADI levels;
• Experimental protocol not
physiologically relevant;
• Associations in observational
studies reported as causation.
Good news (no effects) does not
make interesting story so not told.
Adverse effects in high dose animal
experiments not relevant at ADI levels
Examples:
- cyclamate and saccharin;
- early studies reported evidence of bladder
cancer at high doses;
- extensive mechanism studies show does not
occur at lower amounts and mechanism not relevant to
humans because of difference in metabolism and
excretion;
-included 24 yr study in monkeys showing no
evidence of increased cancer.
Saccharin
• Most (95%) absorbed in the small intestine;
• Absorbed saccharin is rapidly excreted in urine.
• Small amount (5%) to colon and excreted in feces.
• Clear evidence that not a carcinogen in humans
• April 2014 : Health Canada reviews safety and
extends allowed uses
• ADI: 0-5 mg/kg/day
http://www.hc-sc.gc.ca/fn-an/consult/2013-nop-adp-saccharin-saccharine/index-eng.php
Majority of epidemiological studies find no association
between low-calorie sweeteners & cancer
Author
Type of study (N)
Consumption
Conclusions
Olney (1996)
# brain tumors cases in US
Not measured
Increased after approval
Gurney
(1997)
56 brain tumor cases
94 controls
Dietary recall Personal interview
No association
Hardell
(2001)
30 brain tumor cases
45 controls
Recall of lowcalorie soft drinks.
No association
Bunin (2005)
315 child brain tumor cases,
315 controls
Food frequency
by mothers
No association
Lim (2006)
Prospective 473,984 subjects, 5 yr.
Hematopoietic and brain cancers
Food frequency
questionnaires
No associations
Gallus (2007)
Case control; various cancers
(8976 cases, 7028 controls)
Food frequency
questionnaires
No association
Bosetti (2009) Case control; various cancers
(1010 cases, 2107 controls)
Food frequency
questionnaires
No association
Schernham
mer (2012)
Prospective: 22 yr. Nurses’ Health
(77,218 F); Health Professionals
(47,810 M). Hematopoietic cancers
Food frequency
questionnaires
every 4 years
No association when
combined cohorts. Weak
positive with separate
McCullough
(2014)
Prospective: 10 yr. Cancer
Prevention cohort; (100,442 M&F)
Non-Hodgkin lymphoma
Food frequency
questionnaires
every 2 years
No association with
aspartame or diet
beverage consumption
Experimental protocol not
physiologically relevant
• Example:
• Studies where sweetener added
directly to cells or injected into
animals.
- Bypass effect of digestion and absorption
(or lack of absorption).
- Very important for aspartame, steviol
glycosides and sucralose.
What is Aspartame?
Amino Acid
Amino Acid
Methyl
About 200 X sweeting
potency as sugar.
JECFA ADI:
0-40 mg/kg/day
Structure: 2 amino acids & methyl group
•Aspartic acid (aspartate)
•Phenylalanine
These are commonly found in foods!
Aspartame digestion
Small Intestine
Body
Aspartame does not enter
the body as a whole.
Aspartame
Digestion enzymes
Aspartame
Methanol
Methanol
Aspartic acid
+
Phenylalanine
Aspartic acid
Phenylalanine
Just like foods and
proteins, aspartame is
completely digested in
intestine by digestion
enzymes.
Components of digestion
of aspartame are same as
from other foods.
European Food Safety Authority Review of Aspartame, 2013
http://www.efsa.europa.eu/en/topics/topic/aspartame.htm
Other dietary sources of
aspartame digestion products
Food
Aspartame-
Phenylalanine
(mg)
Aspartic
acid (mg)
Methanol
(mg)
90
72
18
606
953
-
58
346
107
24
180
23
sweetened
Soft drink (340 ml)
Non-fat milk
(340 ml)
Tomato Juice
(340 ml)
Orange juice
(340 ml)
How many servings to reach the
safe level established by JECFA?
Food/Beverage
Adult
Child
Powdered drink (8 oz.)
26
9
Gelatin dessert (4 oz.)
34
11
Tabletop sweetener (packet)
80
26
Carbonated soft drink (12 oz.)
70 kg
16
23 kg
5
Aspartame Review by Food
Safety Experts of new studies
• Aspartame has been officially extensively
reviewed 6 times since first approved!
• Most recent – 2013
• Each time concluded:
- Use of aspartame is safe
- Including for pregnant women
- No need to conduct further studies.
Reviewed by EU SCF and EFSA 1997, 2002, 2006, 2009, 2011, 2013;
Magnuson and coauthors, 2007.
Stevia extracts
• Purified extracts from
the leaves of the South
America shrub - Stevia
rebaudiana;
• Sweetness comes from
steviol glycosides, such
as rebaudioside A;
glucose
Extraction
and
purification
O
O
glucose
glucose
O
CH3
H
O
glucose
H
CH3
O
CH2
• Purified glycosides are
30-300x sweet as
sugar;
• Glycosides contain
glucose molecules.
Steviol glycosides: metabolism
glucose
O
O
glucose
glucose
Steviol glycosides
are not absorbed.
Steviol
O
CH3
CH2
H
O
glucose
H
CH3
O
Glucose units removed
by bacteria in large
intestine. Time varies
for different glycosides.
All metabolized to
steviol backbone.
Steviol absorbed in large
intestine, modified by
liver, and excreted.
Steviol glycosides
•
Purified from the leaves of a South America shrub.
•
Are many different forms.
•
All have common steviol backbone, different number and
position of attachments of glucose.
Rebaudioside A (Reb A) - sweetest, most abundant steviol glycoside
•
Reb A is 200-300 sweeter than sugar
ADI = 0 - 4 mg steviol equivalents/kg body weight/day
Applies only to extracts purified to contain >95% steviol glycosides.
– Need to convert from steviol equivalents to glycosides
– i.e. ADI for Reb A = 0 - 12 mg rebaudioside A/kg/day
Sucralose
•
Structure similar to sugar, but 600X sweeter.
•
Only a small amount of sucralose is absorbed and
excreted in urine.
•
Most (85%) of ingested sucralose is not absorbed into
the body; is eliminated in the feces unchanged.
•
Gut microflora unable to hydrolyse sucralose
• ADI : 0-15 mg/kg/day
JECFA assessment of sucralose
http://apps.who.int/food-additives-contaminants-jecfadatabase/PrintPreview.aspx?chemID=2340
Do low-calorie sweeteners
increase appetite? body weight?
Answer – No!
• Hypothesis based on
observational studies
showing positive
correlations between
low-calorie sweeteners
and body weight.
• Cause or result?
• Association does not
establish CAUSE!
Studies conclude low-calorie
sweeteners do not cause weight gain
• Meta-analysis: 16 studies assessing effect of
aspartame on weight loss, found using foods and
drinks sweetened with aspartame instead of sucrose
results in a significant reduction in both energy intakes
and body weight (de la Hunty et al., 2006).
• No evidence that low-calorie sweeteners are cause of
higher body weights in adults (Anderson et al., 2012).
• Short-term randomized controlled trials find low-calorie
sweetener use is BMI neutral or weight-reducing in
overweight/obese adolescents. Long-term data are
lacking (Foreyt et al., 2012).
Meta-Analysis of Randomized Controlled Trials
and Prospective Cohort Studies on LCS and
Body Weight
15 randomized controlled trials (RCTs) and 9 prospective
trials analyzed
-
RCTs: LCS were significantly associated with reduced
body weight, BMI, fat mass and waist circumference
-
Prospective trials: modest positive association between
consumption of LSC and changes in BMI with no significant
associations for weight gain or fat mass
Conclusion: RCT demonstrate that substituting LCS for
sugar modestly reduces body weight, BMI, fat mass, and
waist circumference.
Miller and Perez AJCN 2014
Conclusions on Benefits
Well-conducted clinical studies have shown
that weight loss and weight maintenance is
more successful with use of low-calorie
sweeteners.
Conclusions on Safety
A large body of evidence is required
to support safety, and is critically
reviewed by health authorities.
All approved sweeteners are safe.
No evidence of adverse effects of
non-nutritive sweeteners at levels of
human consumption, by even
highest users.
Thank you!
[email protected]
For More Information
• CalorieControl.org
• Acesulfamek.org
• Aspartame.org
• Cyclamate.org
• Fructose.org
• Polyol.org
• Saccharin.org
• Steviabenefits.org
• Sucralose.org
The Calorie Control Council